After accomplishing what she set out to do at University Hospitals Health System in Cleveland, where she oversaw a major upgrade and full system deployment, Mary Alice Annecharico, RN, decided it was time for a new challenge. So she ventured across Lake Erie to Henry Ford Health System, a large, Detroit-based organization that is transitioning from a home-grown system to Epic’s EMR. In this interview, Annecharico talks about why Henry Ford appealed to her, the path from clinical nursing to CIO, and how her early career experience shapes her current role. She also discusses the importance of knowing what drives an individual, her IT philosophy, and why nurses can make effective CIOs.
- Best practices in CIO onboarding
- Why flexibility and customization have become dirty words
- The importance of total leadership support
- The Epic Way
- Tapping Accenture and Cumberland for consulting help
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It’s becoming almost a mantra of the organization that standardization and effective use of the technology will be the guidelines for decisions that we make moving forward. That’s going be a bitter pill for some incredibly innovative, dynamic clinicians and business units who have been very focused on distinguishing themselves.
That’s the great challenge, and that’s the opportunity that will require that leadership across the organization does not blink. We are moving in this direction and we will help you. We are here to support you. We will move through the process of change with you but we will all embrace it together because that’s what we need to do.
The physicians and clinical advisory groups are looking to her to help make those decisions. She’s describing right up front that some of these choices will be tough and that we anticipate what we see on the horizon as the obstacles that we need to overcome.
Epic does have a very formal process. It does indicate that if you are investing with us in a partnership relationship, it is going to be the Epic way, because we know what will help make you successful.
That’s one of the reasons that we are going to be relying on Accenture and Cumberland, who are our two consultancy groups right now, to help us with training the responses and managing some of the overarching responsibilities that we have to get this project off the ground.
Guerra: When you came in, was there anything specific or significant that you looked at in the way the project was set up or the way it was going — you mentioned some elements of governance—that you looked at and said, ‘I’m not so sure about that, I may want to tweak that.’
Annecharico: Yes there are always those, and I guess that’s the creative tension across all the workgroups that represents how we come to single points of decision and keep moving forward. There are going to be a number of challenges for us in this aggressive time frame, Anthony, that really represent maintaining the status quo in our departmental systems like lab who already have an upgrade strategy in place with the Sunquest environment. The momentum that needs to be maintained there cannot compete with the desired effects of how we create that integration strategy into the complex, comprehensive integrated testing of the lab with Epic before we roll out our pilot.
And those are the kinds of things that right now we are working through to try to determine the solidarity of our timelines or the need for some flexibility and movement in the approach that we have to manage our pilots, both on the practice side as well as the plan for the integrated model for the hospital-based billing and clinical side that will be coming up in 2013.
Guerra: I’m just smiling and thinking that two words that CIOs embraced a long time ago now that make you grimace a little bit are flexibility and customization — when we have to but not any more than what we actually have to at this point, right?
Annecharico: That’s right. Well, it’s becoming almost a mantra of the organization that standardization and effective use of the technology will be the guidelines for decisions that we make moving forward. That’s going be a bitter pill for some incredibly innovative, dynamic clinicians and business units who have been very focused on distinguishing themselves as efficient and effective in their environments.
This is an opportunity for significant change. The clinicians here are absolutely excited. They are very excited about the choice for Epic. They realize that the wave for the future is the direction in which we are going to be moving. They embrace that, and yet today, because we’re in the midst of organizing for the change, they don’t completely have the capacity to reflect on what does that mean for me. And that’s the huge piece; that’s the great challenge, and that’s the opportunity that will require that leadership across the organization does not blink. We are moving in this direction and we will help you. We are here to support you. We will move through the process of change with you but we will all embrace it together because that’s what we need to do.
Guerra: I think of it like with children. You can have a situation where you’re the parent talking about what needs to be done and then some surgeon goes around to the CEO and all of a sudden, the CEO caves — not that the CEO would, but they went to dad instead of going to mom and dad over-ruled and mom, and now you have a big problem.
Annecharico: This is an incredibly thoughtful organization and you can see where each of us realizes who need to bolster up to help them maintain that steady course because they could buckle under the illusion of disquiet at the faculty level. They could buckle at the illusion of disquiet in the business units, and yet all of us are saying that we’ve committed a massive investment of time, energy, talent and resources, and we need to stay the course. And through the discipline that we’re attempting to impose upfront, not in a punitive way at all but the rigor around decision-making and the involvement and investment of physician advisory groups, clinical advisory groups, technology advisory groups, and business advisory groups, decisions will be made in an integrated fashion. We’ll make them once and keep moving; that is becoming the mantra.
Guerra: It is important, I think — and you can react — for everyone to understand that this is going to be hard and here are the storms that may come and let’s be ready for them. They are going to come, so let’s not be surprised when they come and this is how we handle them.
Annecharico: Yes, and that’s a powerful message and one of the reasons that the organization two weeks before — actually it was about a month before — I was made the offer, hired back into the organization a physician who’s credentialed in change management and physician adaption who had spent the bulk of her career within this organization, and went out into the industry and got some experience in helping physicians change behaviors for the right reasons. She is one of the leads for this full implementation and the physicians and clinical advisory groups are looking to her to help make those decisions. And yes, she’s describing right up front that some of these choices will be tough and that we anticipate what we see on the horizon as the obstacles that we need to overcome. And again, we will do this together. It won’t be easy and we will consider enhancements and those things that make it easier for you to use as we move through the process. But the first process is model and that’s what we are.
Guerra: I’d like to talk a little bit about the Epic implementation process. Epic is known for having a very, very formal recipe for success: ‘here’s how you do it; here’s how we do it.’ It’s not extremely flexible. You’re going to do it this way because we know this is what’s going to work. And I don’t mean that in a negative way at all. I interviewed a CIO recently who said his vendor didn’t have that approach. They offered a large degree of flexibility especially, at the departmental level, for the users to create their screens and flows and that turned out to be a little problematic. The flexibility caused some problems because the clinicians didn’t even like what they had created after they created it. So talk to me about Epic’s implementation methodology — how flexible or rigid is it and what are the benefits or any negatives of that.
Annecharico: Well, you could have asked me the question about the experience that University Hospitals. We did fully customize the applications and developed 500 order sets and still had the bumps along the way once we brought the applications live across the landscape of the seven hospitals there. Epic does have a very formal process. It does indicate that if you are investing with us in a partnership relationship, it is going to be the Epic way, because we know what will help make you successful. We guarantee an activation that will lead you to the successful outcomes that you are measuring and this is what you need to do. They are unfolding in that very same manner. What I am beginning to experience in my short time here is because Epic has grown so rapidly, they don’t have a full fleet of A-players who are full varied of experiences and understand the nuances of your organization as fully as what I think Henry Ford was anticipating.
What they did offer and what they have delivered are a composite of resources who have varying degrees of experience under their belt and who are supported by those more experienced in areas that are less familiar to them. Because we are so aggressively moving into the footprint of full implementation mode within the next two months, we believe that there is some exposure in giving a cookie cutter approach to the process of creating the dynamism of change within the organization when no one fully embraces the anticipated change before it is delivered. The cookie cutter or the standardized approach that Epic uses is to deliver to you guidelines and requirements that need to be satisfied and fulfilled within your business and your clinical groups: questions to answer, organization of tables, and the decision tree about where is your master person index schema going to from—is it Epic, which of course they recommend, or is it from another decision point within the organization.
Some of those decision trees that need to be answered and the deliverables that need to go back are, at the moment, competing with the things that we know that we need to do as an organization to organize and stabilize the environment for our teams to be successful. An example of that is that we’ve got 150 folks in training and education in Verona, Wisconsin at this point. They’re back and forth with their modules that they need to become certified in, and therefore, we can’t give them this additional work to get some of these pro-forma profiles built and delivered in the timeframes that Epic is delivering them. That’s one of the reasons that we are going to be relying on Accenture and Cumberland, who are our two consultancy groups right now, to help us with training the responses and managing some of the overarching responsibilities that we have to get this project off the ground.
I also believe that from a positive perspective, the formalized process that Epic is requiring is providing us with the additional layers of rigor that we need to employ as an organization in order to meet the timelines and meet these very rigorous milestones that we are sending forth to be able to deliver on time and deliver with value. Time will tell in terms of how all of that plays out, but I think it is a positive talk, as long as we can, with Epic, manage the expectations and manage, again, the tension that will be created between changing workflow to accommodate Epic or modifying the workflow within our organization to accommodate the changes over periods of time. I think that’s going to be our biggest challenge because there’s such a footprint of change in front of us.